The largest study ever conducted into feedback from NHS service users has found that people skills such as politeness, compassion and a sense of humour are cited most often in people’s feedback about their experience with the NHS, even more so than standards of service.
The research by Paul Baker and Gavin Brookes at Lancaster University was based on an analysis of more than 200,000 comments posted on the NHS Choices website. It will be the focus of an event as part of the annual Economic and Social Research Council’s (ESRC) Festival of Social Science.
“It’s soft skills that people often evaluate their NHS experience on - they associate them with both good and bad service,” says Professor Baker, from the Department of Linguistics and English Language.
Since 2002, NHS trusts in England have had to collect and report on feedback to their services. NHS Choices was launched in 2007 and is the official website of the NHS in England, with more than 48 million visits per month.
Professor Baker and his colleagues set out to determine the key factors behind positive and negative comments on the site. They analysed the words used most frequently in these postings between March 2013 and September 2015.
The comments related mostly to GP practices, followed by hospitals, dentists, pharmacies, care providers as well as other services including acute trusts and mental health.
Overall the study, which was sponsored by NHS England, found that patients rated NHS services three times more positively than negatively. They rated the effectiveness of their treatment and clarity of communication they’d experienced more highly than the interpersonal skills of staff or how appointments and waiting times were handled.
References to the interpersonal skills of staff featured prominently for most services. The exception was for more serious or repeat complaints. In these cases, issues such as poor treatment or long waiting times mattered more than ‘soft’ skills.
Receptionists in particular were the focus of negative comments such as being ‘disrespectful’ and having a ‘bad attitude’.
Age was also a factor, with patients in their 60s and 70s least likely to make negative comments, and those in their twenties the most likely. Younger patients complained about staff members being dismissive of their concerns while older people focused more on appointment availability and issues around prescription services.
Professor Baker added: “While some managers might advocate sending staff on training schemes to improve their interpersonal skills, it could be argued that such skills are being sorely tested due to unprecedented pressures placed on NHS staff - such training schemes may not address these larger-scale structural issues.”
The research highlights how linguistics can provide crucial insights into communication in healthcare, according to Professor Baker.
A separate study into language use in healthcare will also be presented at the ESRC Festival of Social Science event. Elena Semino from Lancaster University and Joanna Zakrzewska from University College London have investigated the use of questionnaires to diagnose pain.
Pain diagnosis is a challenge because patients can find it difficult explaining exactly what their experience is. Doctors therefore rely on written questions to determine quality and severity of pain.
These include the McGill pain questionnaire (MPQ) which is used by the NHS and by healthcare services worldwide. It organises words for pain into 20 different groups, with expressions listed in order of increasing severity.
The researchers analysed MPQs completed by 800 patients being treated for pain without an identifiable cause at the Eastman Dental Hospital in London.
The researchers found that the main weakness of the MPQ design was that patients tended to pick words commonly associated with pain such as ‘tingling’. This was instead of choosing an expression that accurately described the extent of their discomfort.
Professor Semino said: “The study highlights the importance of using evidence from linguistic studies when designing these questionnaires. The goal now is to help develop a new pain diagnosis tool that’s more reliable.”
Professor Baker and Dr Semino will be sharing their findings as part of an event entitled Valuing Language: effective communication in healthcare on 9th November for the general public. The event is part of the ESRC’s flagship annual Festival of Social Science.
It’s soft skills that people often evaluate their NHS experience on - they associate them with both good and bad service
Professor Paul Baker